CAROTID-ARTERY BYPASS IN ACUTE POSTENDARTERECTOMY THROMBOSIS

BACKGROUND: Carotid endarterectomy has demonstrated excellent results over the past 2 decades with combined stroke mortality of <4% in most active centers, However, the optimal technique for surgical reconstruc tion for patients with acute postoperative deficits is more controvers ial. PATIENTS AND METHODS: In the last 10 years (1985 to 1995), we per formed 1,267 carotid endarterectomies, with 17 strokes (1.3%) and 16 d eaths (1.2%), Twenty-four patients developed acute (within 72 hours) p ostoperative neurologic deficits, In 10 patients, the carotid artery w as confirmed patent by duplex scan or angiography, and the neurologic deficit resolved without further therapy, Early reexploration was perf ormed in 14 cases for suspected thrombosis associated with a new neuro logic deficit, In each case, resection of the endarterectomy site and an interposition bypass was performed with greater saphenous vein (11) , jugular vein (2), or polytetrafluoroethylene (2) grafts, (One patien t required a new bypass for acute occlusion of the initial vein bypass .) Postoperatively, 8 patients had complete resolution of their defici t, 3 had minimal residual deficits, and 3 suffered permanent stroke, H owever, 2 of these patients died. RESULTS: Carotid artery bypass with exclusion of the endarterectomy site resulted in improvement in sympto ms in 79% (11 of 14) of the patients and complete resolution in 57% (8 of 14), In long-term follow up (1 to 41 months), there have been no o cclusions and one restenosis requiring revision at 11 months. CONCLUSI ONS: Carotid artery bypass can be performed safely with acceptable res ults, The use of autogenous venous conduits allows reconstruction with an endothelial lined conduit that may improve results in patients wit h acute postoperative neurologic deficit secondary to thrombosis of th e endarterectomized carotid artery.